{"id":135218,"date":"2005-10-20T00:00:00","date_gmt":"2005-10-19T18:30:00","guid":{"rendered":"https:\/\/www.legalindia.com\/judgments\/life-insurance-corporation-of-vs-shri-devi-das-sirsode-on-20-october-2005"},"modified":"2017-07-20T05:56:39","modified_gmt":"2017-07-20T00:26:39","slug":"life-insurance-corporation-of-vs-shri-devi-das-sirsode-on-20-october-2005","status":"publish","type":"post","link":"https:\/\/www.legalindia.com\/judgments\/life-insurance-corporation-of-vs-shri-devi-das-sirsode-on-20-october-2005","title":{"rendered":"Life Insurance Corporation Of &#8230; vs Shri Devi Das Sirsode on 20 October, 2005"},"content":{"rendered":"<div class=\"docsource_main\">National Consumer Disputes Redressal<\/div>\n<div class=\"doc_title\">Life Insurance Corporation Of &#8230; vs Shri Devi Das Sirsode on 20 October, 2005<\/div>\n<pre>  \n \n \n \n \n \n NATIONAL CONSUMER DISPUTES REDRESSALCOMMISSION\n  \n \n \n \n \n \n\n\n\n\n\n\n\n \n\n\n\n NATIONAL\nCONSUMER DISPUTES REDRESSALCOMMISSION \n\n   NEW DELHI \n\n \n\n \u00a0\n\n \n\n \u00a0\n\n  REVISION\nPETITION NO. \n2517 of 2005  \n\n \n\n(From the order dated 22.6.2005 in Appeal No. 1054\/2004\nof the State Commission, Madhya\nPradesh arising out of Order dated\n23.4.2004 in Complaint No. 830\/2003 of the District Forum,   Bhopal, Madhya Pradeshl)\n\n \n\n \u00a0\n\n \n\n \u00a0\n\n \n\nLife Insurance Corporation of   India, \n\n \n\nCareer Agent Branch, 2nd Floor, \n\n \n\nAbove MPFC Office,  \n\n \n\n6, Malviya Nagar,   Bhopal (M.P.) \n\n \n\n  Petitioner \n\n \n\nVersus \n\n \n\n \u00a0\n\n \n\nShri Devi\nDas Sirsode \n\n \n\nJanata Shed No.25,  \n\n \n\nGautam Nagar, \n\n \n\n  Bhopal (M.P.)  Respondents \n\n \n\n \u00a0\n\n \n\nA N D \n\n \n\n \u00a0\n\n  REVISION\nPETITION NO. \n2518 of 2005  \n\n \n\n(From the order dated 22.6.2005 in Appeal\nNo. 105 5\/2004 of the State Commission, Madhya Pradesh arising out of Order dated 23.4.2004 in Complaint No.797\/2003\nof the District Forum,   Bhopal, Madhya Pradesh)\n\n \n\n \u00a0\n\n \n\nLife Insurance Corporation of   India, \n\n \n\nCareer Agent Branch, 2nd Floor, \n\n \n\nAbove MPFC Office,  \n\n \n\n6, Malviya Nagar,   Bhopal (M.P.) \n\n \n\n  Petitioner \n\n \n\nVersus \n\n \n\n \u00a0\n\n \n\nShri Devi\nDas Sirsode \n\n \n\nJanata Shed No.25,  \n\n \n\nGautam Nagar, \n\n \n\n  Bhopal (M.P.)  Respondents \n\n \n\n \u00a0\n\n \n\n \u00a0\n\n \n\n \u00a0\n\n \n\nBEFORE : \n\n \n\n HONBLE MR. JUSTICE M.B.SHAH,\nPRESIDENT. \n\n \n\n DR. P.D. SHENOY, MEMBER. \n\n \n\n \u00a0\n\n \n\nFor the Petitioner in : Mr. S.P. Mittal,\n \n\n \n\nBoth the petitions Advocate \n\n \n\n \u00a0\n\n \n\n  \u00a0\n\n \n\n DATE : \n  20th\n OCTOBER, 2005  \n\n   \u00a0\n\n  O R D\nE R \n\n \n\n  \u00a0\n\n \n\n M.B.SHAH, J.\n<\/pre>\n<p>PRESIDENT.\n<\/p>\n<p> \u00a0<\/p>\n<p> In<br \/>\nboth these Revision Applications question is with regard to interpretation of<br \/>\nclause 10(a) of the Endowment Assurance Policy with Profits<br \/>\n(With Accident Benefit). Complainant<br \/>\nShri Devi Das Sirsode, took the policy for a sum of Rs.25,000\/-<br \/>\nwhich carried accidental benefit. He had also taken second similar policy for a sum of Rs.50,000\/-. Due to an<br \/>\naccident on a railway track, his both legs were amputated from above the knee<br \/>\njoint. His claim for accident benefit<br \/>\ninsurance coverage was however, repudiated by the petitioner  Life Insurance Corporation of<br \/>\nIndia (LIC) on the ground that the disability suffered by the Complainant did<br \/>\nnot constitute permanent disability as contemplated under Clause 10 of the insurance<br \/>\npolicy because till today he was in employment and earning his livelihood. As the amount was not paid, Complainant<br \/>\napproached the District Forum and in both the cases, the District Forum<br \/>\ndirected the LIC to pay the amount of accidental benefit as per the terms of<br \/>\nthe policy. Against the said judgment and order passed by the District Forum,<br \/>\nthe LIC preferred appeals No.1054 of 2004 and 1055 of 2004 before the State<br \/>\nCommission, Madhya Pradesh. The State Commission, after appreciating the<br \/>\nrelevant term of the policy dismissed both the appeals by judgment and order<br \/>\ndated 22.6.2005. Against that judgment and order the aforesaid Revision<br \/>\nPetitions are filed.\n<\/p>\n<p> \u00a0<\/p>\n<p>  The relevant part of the Clause 10(a)<br \/>\nwhich gives benefit to the assured on account of disability is as under:\n<\/p>\n<p>Accident Benefit: If at any<br \/>\ntime when this Policy is in force for the full Sum Assured, the Life Assured,<br \/>\nbefore the expiry of the period for which the premium is payable or before the<br \/>\nPolicy anniversary on which the age nearer birthday of the Life Assured is 65<br \/>\n(whichever is earlier) is involved in an accident resulting in either<br \/>\npermanent disability as hereinafter<br \/>\ndefined or death and the same is proved<br \/>\nto the satisfaction of the Corporation, the Corporation agrees in the case of :\n<\/p>\n<p> \u00a0<\/p>\n<p>(a) Disability<br \/>\nto the Life Assured:- (i) to pay in monthly instalments spread over 10<br \/>\nyears an additional sum equal to the Sum Assured under this Policy. If the Policy becomes a claim before the<br \/>\nexpiry of the said period of 10 years, the disability benefit instalments which<br \/>\nhave not fallen due will be paid along with the claim; (ii) to waive the<br \/>\npayment of future premiums.\n<\/p>\n<p> .\n<\/p>\n<p> \u00a0<\/p>\n<p>The disability above referred to must be disability which is the<br \/>\nresult of an accident and must be total and permanent and such that there is<br \/>\nneither then nor at any time thereafter any work, occupation or profession<br \/>\nthat the Life Assured can ever<br \/>\nsufficiently do or follow to earn<br \/>\nor obtain any wages, compensation or profit.\n<\/p>\n<p> \u00a0<\/p>\n<p>Accidental injuries which independently of all other causes and<br \/>\nwithin ninety days from the happening of such accident result in the<br \/>\nirrecoverable loss of the entire sight of both eyes or in the amputation of<br \/>\nboth hands at or above the wrists, or in the amputation of both feet at or<br \/>\nabove ankles, or in the amputation of one hand at or above the wrist and one<br \/>\nfoot at or above the ankle, shall also be deemed to constitute such<br \/>\ndisability <\/p>\n<p> \u00a0<\/p>\n<p> The<br \/>\nState Commission interpreted the clause 10(a) of the policy and arrived at a<br \/>\nconclusion that in case of a permanent disability the aforesaid clause is<br \/>\nrequired to be read in two parts both independent to each other and is required<br \/>\nto be read disjunctively and it divided<br \/>\nthe clause as stated above and held that:\n<\/p>\n<p> (i) The first part relates to disability which<br \/>\nshould not only be total and permanent but should be such so as to render the<br \/>\ninsured incapable of doing any work, occupation or profession for whole of his<br \/>\nlife and (ii) the second part of the definition is illustrative in nature and<br \/>\nprovides that in case of accidental<br \/>\ninjuries resulting in irrecoverable loss<br \/>\nof entire sight of both the eyes, or in amputation of both the hands at or above wrist, or in amputation of both<br \/>\nfeet at or above ankles or in amputation<br \/>\nof one hand at or above wrist and one<br \/>\nfoot at or above ankle shall also<br \/>\nbe deemed to constitute permanent<br \/>\ndisability. The said<br \/>\npart of the clause is very<br \/>\nclear and it says that such disability<br \/>\nconstitute to permanent disability. The<br \/>\nState Commission emphasised the words<br \/>\nshall also be used in the<br \/>\nlatter part of clause giving meaning to<br \/>\nthe word<br \/>\ndisability and held that it<br \/>\nmakes abundantly clear that<br \/>\nhappening of any of these<br \/>\ncontingencies would also constitute<br \/>\ndisability as envisaged<br \/>\nunder the said clause.\n<\/p>\n<p> \u00a0<\/p>\n<p> In<br \/>\nthe above set of circumstances, once the disability under the second<br \/>\npart is permanent, the LIC was unjustified in repudiating the claim. The State Commission also referred to the<br \/>\ndecision in the case of Asha Goel vs. vs. LIC<br \/>\n AIR 2001 SC 549 =(2001) 2 SCC 160 wherein the Apex Court cautioned<br \/>\nthe officers of the LIC against<br \/>\nmechanical rejection of the claims<br \/>\nof policy holders by observing as under:\n<\/p>\n<p> \u00a0<\/p>\n<p>In the course<br \/>\nof time the Corporation has grown in size and at present it is one of the<br \/>\nlargest public sector financial undertakings.<br \/>\nThe public in general and crores of policy holders in particular look<br \/>\nforward to prompt and efficient service from the Corporation. Therefore, the authorities-in-charge of management<br \/>\nof the affairs of the Corporation should bear in mind that its credibility and<br \/>\nreputation depend on its prompt and<br \/>\nefficient service. Therefore the<br \/>\napproach of the Corporation in the matter of repudiation of a policy admittedly issued by it<br \/>\nshould be one of extreme care and caution.\n<\/p>\n<p>It should not be dealt with in a mechanical and routine manner.\n<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> In<br \/>\nour view, the aforesaid reasoning and interpretation cannot be said in any way<br \/>\nerroneous. The State Commission rightly<br \/>\nread the clause giving meaning to the word disability by dividing it into two<br \/>\nparts. Firstly, the disability which is the result of an accident should be<br \/>\ntotal and permanent, such that after the<br \/>\naccident assured cannot do any work,. Occupation or profession to obtain any wages, compensation or<br \/>\nprofit. Secondly, if the accidental injuries has resulted<br \/>\nin permanent loss of the limbs as<br \/>\nmentioned therein, then it shall<br \/>\nalso be deemed to constitute such disability. Hence, first part deals with the capacity of<br \/>\nthe assured to earn livelihood, and the second part deals with the injury to<br \/>\nthe limbs as mentioned above. In our view, this is the only reasonable<br \/>\ninterpretation of the reading of the said condition of the insurance<br \/>\npolicy. May be that it is clumsily<br \/>\ndrafted by not providing the condition into two parts. However, it is to be noted that before the<br \/>\nsecond part it is not provided that in addition to what is provided in the<br \/>\nfirst part is required to be satisfied.\n<\/p>\n<p>On the contrary, the second part is a deeming fiction which provides<br \/>\nthat injuries to the limb, as mentioned in the said condition, would also<br \/>\ndeemed to be constituted such disability.\n<\/p>\n<p> \u00a0<\/p>\n<p> In<br \/>\nthe present case, there is no dispute<br \/>\nthat disability was the result of accident. Secondly, it was permanent. The accidental injuries resulted in<br \/>\nirrecoverable loss because of amputation<br \/>\nof both the feet at or above the ankles.\n<\/p>\n<p>If this is so,<br \/>\nthen, if the employer continues the assured in service<br \/>\non compassionate ground or otherwise, it<br \/>\nwould not mean that the assured has not suffered permanent disability as defined under the<br \/>\nclause. In any set of<br \/>\ncircumstances, in such a case, such ex<br \/>\ngratia or on compassionate ground, continuing the assured in service by the<br \/>\nemployer (may be the Government or other statutory body or private individual) is not for the<br \/>\nbenefit of the Insurance Company. The<br \/>\nInsurance Company cannot deprive the assured the benefit under the policy.\n<\/p>\n<p> Further, in any case if the<br \/>\nterms of the policy are vague, it should be interpreted for the benefit<br \/>\nof the assured as it would serve the<br \/>\npurpose and object of getting insurance coverage. The law on this subject is settled by the   Apex Court in<br \/>\nSkandia Insurance Co. Ltd. Vs. Kokilaben<br \/>\nChandravadan &amp; Ors. (1987) 2 SCC 654, <a href=\"\/doc\/12151774\/\">Shashi Gupta vs. LIC of   India<\/a> -(1995) Suppl 1 SCC 754; B.V. Nagaraju vs.<br \/>\nM\/s. Oriental Insruance Co. Ltd.  (1996) 4 SCC<br \/>\n648; <a href=\"\/doc\/106081297\/\">LIC vs. Raj Kumar Rajgarhia &amp; Anr.<\/a> (1999) 3 SCC 465.\n<\/p>\n<p> \u00a0<\/p>\n<p> Finally, we observe that it<br \/>\nis necessary for the officers of the LIC<br \/>\nto change their negative approach in dealing with such claim and the<br \/>\ninsurance coverage should not be nullified by backward looking interpretation<br \/>\nof the Act. The terms and conditions of<br \/>\nthe policy should not be read with a non-benevolent eye which would result in<br \/>\nfrustrating the purpose and philosophy of the legislation without being<br \/>\ninformed of the true goals sought to be achieved by the LIC Act.\n<\/p>\n<p> \u00a0<\/p>\n<p> In<br \/>\nthis view of the matter, it cannot be said that the order passed by the State Commission confirming the<br \/>\norder of the District Forum, is in any way erroneous. In the result, these revision petitions are<br \/>\ndismissed.\n<\/p>\n<p> Sd\/<\/p>\n<p> &#8230;J.\n<\/p>\n<p> (M.B.SHAH) <\/p>\n<p>  PRESIDENT<\/p>\n<p> \u00a0<\/p>\n<p>  Sd\/<\/p>\n<p>..\n<\/p>\n<p> (P.D.SHENOY) <\/p>\n<p>  MEMBER<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"<p>National Consumer Disputes Redressal Life Insurance Corporation Of &#8230; vs Shri Devi Das Sirsode on 20 October, 2005 NATIONAL CONSUMER DISPUTES REDRESSALCOMMISSION NATIONAL CONSUMER DISPUTES REDRESSALCOMMISSION NEW DELHI \u00a0 \u00a0 REVISION PETITION NO. 2517 of 2005 (From the order dated 22.6.2005 in Appeal No. 1054\/2004 of the State Commission, Madhya Pradesh arising out of Order [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-135218","post","type-post","status-publish","format-standard","hentry","category-judgements"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Life Insurance Corporation Of ... vs Shri Devi Das Sirsode on 20 October, 2005 - Free Judgements of Supreme Court &amp; 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